Efficacy of epidural methylprednisolone in radicular pain
Keywords:
Pain, Steroids, Anesthesia, Epidural, Analgesia, Fluoroscopy
Abstract
Introduction: Degenerative disc disease is a prevalent and disabling disease. When the conservative treatment fails to obtain pain relief, epidural steroids are an alternative frequently used worldwide.
Objectives: To evaluate the efficacy and safety of epidural methylprednisolone in patients with radicular pain.
Methodology: Descriptive longitudinal retrospective study in patients with chronic radicular pain who received fluoroscopy-guided interventional treatment, between July 2010 and December 2011 at Instituto Colombiano del Dolor (Medellín-Colombia), to determine the efficacy and safety of epidural methylprednisolone in clinical practice. Pain relief was followed using the visual analogue scale, during at least 8 weeks.
Results: 254 patients were analyzed. The mean age of the patients was 52.8 years (SD ± 15); 52.8% were men. The main diagnosis was lower-limb radicular pain (87.7%). The most frequent procedures were transforaminal lumbar injection (54.3%) and interlaminar lumbar injection (17.7%). The proportion of patients with more than 50% pain relief 50% was 85.8%. There were no differences in efficacy between the procedures. Pain improvement lasted more than 8 weeks in 55% of patients. The incidence of complications was lower than 1%.
Conclusions: When radicular pain is refractory to conservative treatment based on pharmacological and physical therapy, epidural methylprednisolone is an effective and safe method in our setting.
References
1. Duffy L. Low back pain:an approach to diagnosis and management. Prim Care Clin Office Pract. 2010;37:729-41.
2. Bratton R. Assessment and management of acute low back pain. Am Fam Physician. 1999;60:2299-308.
3. Kinkade S. Evaluation and treatment of acute low back pain. Am Fam Physician. 2007;75:1181-8.
4. Haldeman S, Dagenais S. A supermarket approach to the evidence-informed management of chronic low back pain. Spine J. 2008;8:1-7.
5. Last A, Hulbert K. Chronic low back pain: evaluation and management. Am Fam Physician. 2009;79:1067-74.
6. Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007;10:185-212.
7. Deer T, Ranson M, Kapural L, Diwan SA. Guidelines for the proper use of epidural steroid injections for the chronic pain patient. Tech Reg Anesth Pain Manag. 2009;13:288-95.
8. Friedly J, Standaert C, Chan L. Epidemiology of care: the back pain dilemma. Phys Med Rehabil Clin N Am. 2010;21:659-77.
9. Katz S, editor. The burden of musculoskeletal diseases in the United States. Rosemont, IL: Bone and Joint Decade, American Academy of Orthopaedic Surgeons; 2008.
10. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine. 2006;31:2724-7.
11. Andersson GB. Epidemiological features of chronic low back pain. Lancet. 1999;354:581-5.
12. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344:363-70.
13. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8:8-20.
14. El dolor lumbar. JANO. 2003. VOL. LXV N.° 1.499,1853-61.
15. Deyo RA, Loeser JD, Bigos SF. Herniated lumbar intervertebral disk. Ann Intern Med. 1990;112:598-603.
16. Deyo RA, Rainville J, Kent D. What can the history and physical examination tell us about low back pain? JAMA. 1992;268:760-5.
17. Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med. 1988;3:230-8.
18. Stout A. Epidural steroid injections for low back pain. Phys Med Rehabil Clin N Am. 2010;21:825-34.
19. Fischgrund JS, Montgomery DM. Diagnosis and treatment of discogenic low back pain. Orthop Rev. 1993;22:311-8.
20. Borenstein, David G. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Curr Opin Rheumatol. 2001;13:128-34.
21. Leone A, Cianfoni A, Cerase A. Lumbar spondylolysis a review. Skeletal Radiol. 2011;40:683-700.
22. Kawakami M, Weinstein J, Chatani K. Experimental lumbar radiculopathy. Spine. 1994;19:1795-802.
23. Govind J. Lumbar radicular pain. Aust Fam Physician. 2004;33:409-12.
24. Zapata J, Covarrubias A, Guevara U. Evaluación de los esteroides epidurales en el tratamiento del dolor de espalda baja. Rev Mex Anestesiol. 2009;32:19-25.
25. Leslie Ng, Chaudhary N, Philip S. The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain: a randomized, double-blind, controlled trial. Spine. 2005;30:857-62.
26. Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St Pierre A, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med. 1997;336:1634-40.
27. Ridley MG, Kingsley GH, Gibson T, Grahame R. Outpatient lumbar epidural corticosteroid injection in the management of sciatica. Br J Rheumatol. 1988;27:295-9.
28. Castagnera L, Maurette P, Pointillart V, Vital JM, Erny P, Senegas J. Long-term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain. Pain. 1994;58:239-43.
29. Dilke TF, Burr HC, Grahame R. Extradural corticosteroid injection in the management of lumbar nerve root compression. Br Med J. 1973;2:635-7.
30. Pirbudak L, Karakurum G, Oner U, Gulec A, Karadasli H. Epidural corticosteroid injection and amitriptyline for the treatment of chronic low back pain associated with radiculopathy. Pain Clin. 2003;15:247-53.
31. Buttermann GR. The effect of spinal steroid injections for degenerative disc disease. Spine J. 2004;4:495-505.
32. Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study. J Bone Joint Surg Am. 2004;86-A:670-9.
33. Staal J, De Bie RA, De Vet HC, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low back pain. Spine. 2008;34:49-59.
34. Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, et al. The effect of nerve root injections on the need for operative treatment of lumbar radicular pain. J Bone Joint Surg Am. 2000;82:1589-93.
35. Benedetti E, Siriwetchadarak R, Stanec J, Rosenquist R. Epidural steroid injections: complications and management. Tech Reg Anesth Pain Manag. 2009;13:236-50.
36. Ospina A, Campuzano D, Hincapié E, Vásquez L, Montoya E, Zapata I, et al. Eficacia del bloqueo facetario en pacientes con síndrome facetario lumbar. Rev Colomb Anestesiol. 2012;40:177-82.
37. Dias D, Frerichsa E, Martins F. Incidencia de complicaciones neurológicas y cefalea pospunción dural luego de anestesia regional en la práctica obstétrica: un estudio retrospectivo de 2399 pacientes. Rev Colomb Anestesiol. 2014;42:28-32.
38. Hartog A. Interventional treatment for low back pain: general risks. Phys Med Rehabil Clin N Am. 2010;21:819-23.
39. Abram SE, Cherwenka RW. Transient headache immediately following epidural steroid injection. Anesthesiology. 1979;50:461-2.
40. Katz JA, Lukin R, Bridenbaugh PO, Gunzenhauser L. Subdural intracranial air: an unusual cause of headache after epidural steroid injection. Anesthesiology. 1991;74:615-8.
41. Ozdemir O, Calisaneller T, Yildirim E, Altinors N. Acute intracranial subdural hematoma after epidural steroid injection: a case report. J Manipulative Physiol Ther. 2007;30:536-8.
42. Vaughan DJ, Stirrup CA, Robinson PN. Cranial subdural haematoma associated with dural puncture in labour. Br J Anaesth. 2000;84:518-20.
43. Ho KY, Manghnani P. Acute monoplegia after lysis of epidural adhesions: a case report. Pain Pract. 2008;8:404-7.
44. Kubin P, Gupta A, Oscarsso A, Axelsson K, Bengtsson M. Two cases of cauda equina syndrome following spinal-epidural anesthesia. Reg Anesth Pain Med. 1997;22:447-50.
45. Gonzalez C, Enriquez L, Cruz C. Aracnoiditis postanestesia raquídea para cesárea. Rev Colomb Anestesiol. 2012;40: 150-2.
46. Gottlieb NL, Riskin WG. Complications of local corticosteroid injections. J Am Med Assoc. 1980;243:1547-8.
47. Rivera R, Arcila M. Infusión epidural cervical para tratamiento del dolor por herpes zoster. Reporte de caso con revisión temática. Rev Colomb Anestesiol. 2013;41:291-7.
48. Spaccarelli K. Lumbar and caudal epidural corticosteroid injections. Mayo Clin Proc. 1996;71:169-78.
49. Young W. Transient blindness after lumbar epidural steroid injection: a case report and literature review. Spine. 2002;27:476-7.
50. Botwin KP, Castellanos R, Rao S, Hanna AF, Torres Ramos FM, Gruber RD, et al. Complications of fluoroscopically guided interlaminar cervical epidural injections. Arch Phys Med Rehabil. 2003;84:627-33.
51. Pizzimenti J, Daniel K. Central serous chorioretinopathy after epidural steroid injection. Pharmacotherapy. 2014;25:1141-6.
52. Cicala RS, Westbrook L, Angel JJ. Side effects and complications of cervical epidural steroid injections. J Pain Symptom Manage. 1989;4:64-6.
53. Kim Ch, Issa MA, Vaglienti RM. Flushing following interlaminar lumbar epidural steroid injection with dexamethasone. Pain Physician. 2010;13:481-4.
54. Kim RC, Porter RW, Choi BH, Kim SW. Myelopathy after intrathecal administration of hypertonic saline. Neurosurgery. 1988;22:942-5.
2. Bratton R. Assessment and management of acute low back pain. Am Fam Physician. 1999;60:2299-308.
3. Kinkade S. Evaluation and treatment of acute low back pain. Am Fam Physician. 2007;75:1181-8.
4. Haldeman S, Dagenais S. A supermarket approach to the evidence-informed management of chronic low back pain. Spine J. 2008;8:1-7.
5. Last A, Hulbert K. Chronic low back pain: evaluation and management. Am Fam Physician. 2009;79:1067-74.
6. Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007;10:185-212.
7. Deer T, Ranson M, Kapural L, Diwan SA. Guidelines for the proper use of epidural steroid injections for the chronic pain patient. Tech Reg Anesth Pain Manag. 2009;13:288-95.
8. Friedly J, Standaert C, Chan L. Epidemiology of care: the back pain dilemma. Phys Med Rehabil Clin N Am. 2010;21:659-77.
9. Katz S, editor. The burden of musculoskeletal diseases in the United States. Rosemont, IL: Bone and Joint Decade, American Academy of Orthopaedic Surgeons; 2008.
10. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine. 2006;31:2724-7.
11. Andersson GB. Epidemiological features of chronic low back pain. Lancet. 1999;354:581-5.
12. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344:363-70.
13. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8:8-20.
14. El dolor lumbar. JANO. 2003. VOL. LXV N.° 1.499,1853-61.
15. Deyo RA, Loeser JD, Bigos SF. Herniated lumbar intervertebral disk. Ann Intern Med. 1990;112:598-603.
16. Deyo RA, Rainville J, Kent D. What can the history and physical examination tell us about low back pain? JAMA. 1992;268:760-5.
17. Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med. 1988;3:230-8.
18. Stout A. Epidural steroid injections for low back pain. Phys Med Rehabil Clin N Am. 2010;21:825-34.
19. Fischgrund JS, Montgomery DM. Diagnosis and treatment of discogenic low back pain. Orthop Rev. 1993;22:311-8.
20. Borenstein, David G. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Curr Opin Rheumatol. 2001;13:128-34.
21. Leone A, Cianfoni A, Cerase A. Lumbar spondylolysis a review. Skeletal Radiol. 2011;40:683-700.
22. Kawakami M, Weinstein J, Chatani K. Experimental lumbar radiculopathy. Spine. 1994;19:1795-802.
23. Govind J. Lumbar radicular pain. Aust Fam Physician. 2004;33:409-12.
24. Zapata J, Covarrubias A, Guevara U. Evaluación de los esteroides epidurales en el tratamiento del dolor de espalda baja. Rev Mex Anestesiol. 2009;32:19-25.
25. Leslie Ng, Chaudhary N, Philip S. The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain: a randomized, double-blind, controlled trial. Spine. 2005;30:857-62.
26. Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St Pierre A, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med. 1997;336:1634-40.
27. Ridley MG, Kingsley GH, Gibson T, Grahame R. Outpatient lumbar epidural corticosteroid injection in the management of sciatica. Br J Rheumatol. 1988;27:295-9.
28. Castagnera L, Maurette P, Pointillart V, Vital JM, Erny P, Senegas J. Long-term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain. Pain. 1994;58:239-43.
29. Dilke TF, Burr HC, Grahame R. Extradural corticosteroid injection in the management of lumbar nerve root compression. Br Med J. 1973;2:635-7.
30. Pirbudak L, Karakurum G, Oner U, Gulec A, Karadasli H. Epidural corticosteroid injection and amitriptyline for the treatment of chronic low back pain associated with radiculopathy. Pain Clin. 2003;15:247-53.
31. Buttermann GR. The effect of spinal steroid injections for degenerative disc disease. Spine J. 2004;4:495-505.
32. Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study. J Bone Joint Surg Am. 2004;86-A:670-9.
33. Staal J, De Bie RA, De Vet HC, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low back pain. Spine. 2008;34:49-59.
34. Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, et al. The effect of nerve root injections on the need for operative treatment of lumbar radicular pain. J Bone Joint Surg Am. 2000;82:1589-93.
35. Benedetti E, Siriwetchadarak R, Stanec J, Rosenquist R. Epidural steroid injections: complications and management. Tech Reg Anesth Pain Manag. 2009;13:236-50.
36. Ospina A, Campuzano D, Hincapié E, Vásquez L, Montoya E, Zapata I, et al. Eficacia del bloqueo facetario en pacientes con síndrome facetario lumbar. Rev Colomb Anestesiol. 2012;40:177-82.
37. Dias D, Frerichsa E, Martins F. Incidencia de complicaciones neurológicas y cefalea pospunción dural luego de anestesia regional en la práctica obstétrica: un estudio retrospectivo de 2399 pacientes. Rev Colomb Anestesiol. 2014;42:28-32.
38. Hartog A. Interventional treatment for low back pain: general risks. Phys Med Rehabil Clin N Am. 2010;21:819-23.
39. Abram SE, Cherwenka RW. Transient headache immediately following epidural steroid injection. Anesthesiology. 1979;50:461-2.
40. Katz JA, Lukin R, Bridenbaugh PO, Gunzenhauser L. Subdural intracranial air: an unusual cause of headache after epidural steroid injection. Anesthesiology. 1991;74:615-8.
41. Ozdemir O, Calisaneller T, Yildirim E, Altinors N. Acute intracranial subdural hematoma after epidural steroid injection: a case report. J Manipulative Physiol Ther. 2007;30:536-8.
42. Vaughan DJ, Stirrup CA, Robinson PN. Cranial subdural haematoma associated with dural puncture in labour. Br J Anaesth. 2000;84:518-20.
43. Ho KY, Manghnani P. Acute monoplegia after lysis of epidural adhesions: a case report. Pain Pract. 2008;8:404-7.
44. Kubin P, Gupta A, Oscarsso A, Axelsson K, Bengtsson M. Two cases of cauda equina syndrome following spinal-epidural anesthesia. Reg Anesth Pain Med. 1997;22:447-50.
45. Gonzalez C, Enriquez L, Cruz C. Aracnoiditis postanestesia raquídea para cesárea. Rev Colomb Anestesiol. 2012;40: 150-2.
46. Gottlieb NL, Riskin WG. Complications of local corticosteroid injections. J Am Med Assoc. 1980;243:1547-8.
47. Rivera R, Arcila M. Infusión epidural cervical para tratamiento del dolor por herpes zoster. Reporte de caso con revisión temática. Rev Colomb Anestesiol. 2013;41:291-7.
48. Spaccarelli K. Lumbar and caudal epidural corticosteroid injections. Mayo Clin Proc. 1996;71:169-78.
49. Young W. Transient blindness after lumbar epidural steroid injection: a case report and literature review. Spine. 2002;27:476-7.
50. Botwin KP, Castellanos R, Rao S, Hanna AF, Torres Ramos FM, Gruber RD, et al. Complications of fluoroscopically guided interlaminar cervical epidural injections. Arch Phys Med Rehabil. 2003;84:627-33.
51. Pizzimenti J, Daniel K. Central serous chorioretinopathy after epidural steroid injection. Pharmacotherapy. 2014;25:1141-6.
52. Cicala RS, Westbrook L, Angel JJ. Side effects and complications of cervical epidural steroid injections. J Pain Symptom Manage. 1989;4:64-6.
53. Kim Ch, Issa MA, Vaglienti RM. Flushing following interlaminar lumbar epidural steroid injection with dexamethasone. Pain Physician. 2010;13:481-4.
54. Kim RC, Porter RW, Choi BH, Kim SW. Myelopathy after intrathecal administration of hypertonic saline. Neurosurgery. 1988;22:942-5.
How to Cite
1.
Álvarez Correa A, Rivera Díaz RC, Arcila Lotero MA. Efficacy of epidural methylprednisolone in radicular pain. Colomb. J. Anesthesiol. [Internet]. 2015 Jan. 1 [cited 2024 Apr. 24];43(1):61-7. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/484
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2015-01-01
How to Cite
1.
Álvarez Correa A, Rivera Díaz RC, Arcila Lotero MA. Efficacy of epidural methylprednisolone in radicular pain. Colomb. J. Anesthesiol. [Internet]. 2015 Jan. 1 [cited 2024 Apr. 24];43(1):61-7. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/484
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